I'm Thankful For...

It's daunting being a doctor. Sure there is the respect, and yes there is a steady income, but no one tells you about the threat of constant upheaval. No one warns you that with new phase of your training, you run the risk of moving to a completely different part of the world. And with that risk, your social life becomes a pinball machine of scattered friends and family. The odds are against you - chances are you will grow apart from your closest friends, and your relationship will come to a crossroads: to stay together or move both your lives across country together. 

So here's to hoping that your boyfriend/husband is either a very successful business man who can request to transfer wherever he wants, or alternatively, unemployed.

I know a registrar who's consigned his life to being a wild single man who lives for weekends of debauchery. That is until he gets a consultant number and he can finally live out his dream of settling down. He's 28 and still waiting for that number. For a man that's fine. For a woman… In lectures they teach us that a woman is at her most fertile, her prime reproductive state, at 19 years old. I turn 24 in a couple weeks and my eggs are rapidly dying off as I type this.

But it's no biggie! I'm thankful for the change. The idea of a brand new unexplored city is very exciting and I'm impatient to start my training (slash receive a salary). More importantly, I'm thankful for the individuals I've come to love and adore. Although the thought of losing touch over the course of our foundation years and speciality training devastates me, I've at least got some pretty spectacular memories. For example, I'll look back to this weekend and think of our epic Thanksgiving dinner. I'll picture that table groaning under the weight of nine side dishes, four puddings and an 8kg titan called Thomas the Turkey, and then imagine all 16 of us on the floor, eyes glazed over and cradling our little food babies (Thomas Jrs). Plus a side shot of the 14 bottles of wine in the corner. 

So here's to our future as FY doctors! In the next 10 days, when our FPAS applications come through, may we are all be placed exactly where we want to be placed, and if it's not, that it will turn out to be a blessing in disguise. Even if we're stuck in Buckfuck, UK. Happy Thanksgiving!

Cardiac Arrest

Just saw my first cardiac arrest and death. While they were pushing the adrenaline, one of the doctors goes "pH of 6.98" and then made a hand gesture slicing across his neck. 

The death of a man doesn't really bother me. I understand that at 87 years old, he was at the end of his life and this was meant to be a procedure that would give him another 5 or 10 years more. But what freaks me out is the way the cardiologist reacted - consultant refused to tell the emergency contact that her friend had just died, and was very keen to move on to the next procedure. 

"We're behind schedule, let's move over to the other cath lab. The nurses will clear up this mess." 

Is that what happens when you've seen death too many times? That you don't even respect it anymore? That's screwed up.

Finding The One

A senior registrar was standing next to me during an angiogram. At one point he mutters "beautiful" under his breath. I asked him what he was referring to and he replied "the moment the needle hits the femoral artery and the blood comes out of the other end in a pulsing gush". He repeated that it was a beautiful sight, and that as weird as it sounds, cardiology just turns him on. 

Later, a different registrar asked me if I had any idea what speciality I wanted to do. I replied honestly with O&G. She smiled at me and said "don't worry, we'll change that." The confidence she has in the allure of cardiology is incredible. 

This rotation I've realised that you can't force your love for medicine. This cardiology rotation has been one of my favourites, and I have enjoyed respiratory, paediatrics, even gastro and ortho on previous rotations. But nothing gets me going like obstetrics. C-sections make me want to jump out of bed at 6 in the morning, and stay on the labour ward until well past 5PM. And gynaecology makes my heart swell, especially when you reassure a patient that she can still have children. Honestly, the fact is I just don't feel the same about an angiogram or a funky coloured sputum sample. 

Finding the speciality you will commit the rest of your life to is just like what they say about Mr. Right - when you've found it, you'll just know it's The One. 

Highlight of My Week

On the ward round with the cardiology team, one of the patients looked particularly oedematous. She seemed fluid overloaded so I wrote up a blood form to check her electrolytes before the team could increase her diuretics.

I found the nurse to ask her to take the blood sample, and she said "Sure! I've got a medical student with me, he'll do it." She took my request, turned to the other student and passed him the form I had just written up...

HAH! I'm delegating my jobs to medical students, so I'm basically already a real doctor.

Sometimes it sucks to be a medical student because no one knows your name, no one cares that you exist. Today was not one of those days.

One day in Cardiology

The ECHO Meeting. They pulled up the images of a patient with a mahooooosive post-MI right ventricular anuerysm with a laminar thrombus. She needs to get corrective surgery before her heart literally bursts. Or collapses from a stroke when that thrombus shoots up into her brain. 

The Cardiology Patients. The consultant had a private patient admitted for shortness of breath. On examination, he had splinter haemorrhages on his nails, a ventricular heave, and tricuspid regurgitation (pan-systolic murmur loudest in the tricuspid region - and I identified it!). Later on, we were notified that the patient had deteriorated and had become dyspnoeic and anuric with an ABG lactate of 6. I watched as the consultant immediately ran off to make sure his rich little private patient didn't crash and die on him. 

The Catheter Lab. Angiograms, where contrast is injected into the chambers of the heart and its own blood supply. Isn't it weird to think that the heart needs to pump blood to itself too? I watched as the coronary arteries filled to outline the shape of the heart, while the ventricle pumped out blood in real time. Then the insertion of a dual-chamber pacemaker. When checking for stabilisation, the doctors asked the patient on the operating table to cough. Turns out the patient was fully conscious despite having electric wires were being twisted into his heart muscle.  

The science of the heart is remarkably straightforward - a muscular pump that pushes blood throughout your body. We take it for granted that it functions perfectly, but we forget that with each heartbeat, things could go terribly wrong.

A coronary angiogram

Antes y Despues

Before I left for elective, I told my friends I was going to have a defining moment, a tremendous epiphany that would change my life forever. I also told them that whatever it was (a jungle creature, the wise words of a shaman), I was going to immortalise it with a tattoo.

Except nothing happened. I don't have anything symbolic to get inked as a reminder of my 4th year elective. There was no moment where I witnessed the chains of poverty, or the gravity of life. And maybe that's a good thing because now I don't have some cliche tattoo of a jaguar prowling across my back.

But that's not to say I haven't changed. I feel and act the same, but something's different. It's just been such a slight and gradual adjustment that I've hardly noticed it. The only way I can identify it is by doing a before and after, comparing the beginning of the trip to the present, waiting for the last leg of my flights home.




Before, my favorite words were cool, dude, and awesome. 
After, my favorite words are que linda, claro, y buena onda.

Before, I flushed with a clear conscious.
After, I think before I flush, just in case the sewage system can't handle it.

Before, I was listening to the Twelves, Munchi, and Afrojack.
After, I'm listening to reggaeton, electronic tango and a crazy jungle song which loosely translates into I Won't Be Your Handkerchief Anymore.

Before, my Spanish sucked.
After, my cab ride to the airport was about the upcoming elections, lack of democracy, and failings of the Argentinean health system.

Before, I refused to eat an empanada because it looks like a curry puff. 
After, it's no Old Chang Kee, but a freshly baked empanada de lomo picante is pretty damn delicious (Daddy, I'm talking to you).

Before, I hated dancing with a guy.
After, doesn't matter if he's got a pot belly, grey hair, and smells of stale cigarettes - if he marks with clarity and is a creative dancer, I'm going to tango with him all night.

Before, I was excited for a South American romance. 
After, the women are a million times better than the men <3

Before, I could tell the difference between a Peruvian and an Argentinean.
After, I can't tell the difference between a Peruvian, Argentinean, Spaniard, Portuguese, German, Mexican, Haitian, or Indonesian.

Before, I wasn't sure if I'd like South America. 
After, in some parts of Peru I felt like I was back in South East Asia, and I felt more at home with Argentineans than I have with any other culture.

Before, I thought if you gave a villager anti-parasites, they would be grateful.
After, I know some will lie about their symptoms to get more pills and free soap.

Before, I supported NGOs and Western aid. 
After, I realise that without an intimate understanding of the local socioeconomic climate, it's a waste of time, effort and resources.

Before, I thought medicine could save the world.
After, I think clinical medicine on its own hardly changes anything.



So even if I haven't had that defining moment or come back a changed person, these past 10 weeks have been unreal. I know for a fact that never again in my life will I ever have a chance to explore the Amazon like I did in Peru (thank you Amazon Promise). And that I'm going straight back to Argentina the moment I have a chance to because I simply haven't had enough.

Thanks to everyone for following me on my elective. For those of you who care to continue, my next trip is MBBS 5, the last year of medical school. It promises to be complete with the fascinating drama of job application stress, placements in the the middle of nowhere England, and finding ways to make this final year of university (read: freedom) absolutely unforgettable.

But for now - suerte mis amigos, chau sudamerica, and for your listening pleasure... "Ya No Sere Mas Tu Pañuelito"!

Street vendors of Buenos Aires

Imagine a guy, the most hipster-ish guy you know. Skinny grey jeans, black graphic tee, tall lanky frame.

There's two of them walking down the street. Both of them are carrying those metal keg backpacks you see at stadiums and events to dispense beer from. A car drives by, stops, and the window rolls down. "¿Café chicos? ¡Dos por favor!"

The two hipsters turn around, and instead of beer the metal drums read "Columbian Café." Eyeing up the driver through their red Wayfarers, they decide to walk over. They take their time, lighting up their rolled cigarettes at the crossing. Then, while taking a big drag from his cig, one fills up a styrofoam cup of coffee while the other guy tops it up with sugar. They lean on the side of the car, nonchalantly smoking and chatting while waiting for their change. The driver gives them 4 pesos and they're off, strolling down the road to look for more customers.

Who knew street food could look so wicked? Who knew that in this city, it would be considered cool to walk the streets as roaming baristas. I'll bet they do something similar for wine... Imagine a massive DJ night out, and instead of beer or coffee, hipsters in fluorescent clothes and cool trainers sell wine by the cup. Ha. Only in Buenos Aires...